Transcript Request Form Nyack College
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1ATTN: Transcript Request
TRANSCRIPT
Office of the Institutional Registrar
Nyack College
REQUEST FORM
350 North Highland Avenue
Nyack, NY 10960
Fax (845) 348-3918
(Please print.) [** Required Information!]
Phone (845) 675-4732
E-mail Transcripts@Nyack.edu
ID#____________
Student
**Name: _______________________________________________
**Name as student: _______________________________________
Address: _______________________________________________
**Home Phone: __________________________________________
________________________________________________________
E-mail: __________________________________________________
SSN: ________--________--**_________ **Birth date:___________
Daytime contact / cell number:_____________________________
STATUS:
Nyack program(s) from which transcript(s) should be issued:
______(STILL in) ______(NOT in) attendance
______Traditional Undergrad
______MSOL
______Graduated ________________(month/yr)
______ADCP / SADE / OM
______MBA
HOLD OPTIONS: (If not checked, transcripts will be sent “as is”)
______ATS (Seminary)
______MSEd
______Send transcript(s) as it is currently
______AGSC (MA Counseling)
______Pinebrook Jr College
______Hold for current semester grades
______Hold until grad date and degree are put on transcript
Approx. Dates Attended: _________________________________
unofficial
SENDING INFORMATION: (can FAX
only) We cannot e-mail any transcripts.
1) _____ # of Official (mail only)
_____ # of Unofficial
2) _____ # of Official (mail only)
_____ # of Unofficial
_______________________________________________________
________________________________________________________
_______________________________________________________
________________________________________________________
_______________________________________________________
________________________________________________________
_______________________________________________________
________________________________________________________
HANDWRITTEN
(required!)
**
SIGNATURE
: ________________________________________________ Date: _______________
PAYMENT OPTIONS for THIS transcript order:
______Regular UNOFFICIAL (leaves office/ faxed in 5-7 business days.) No cost by regular mail or fax.
______UNOFFICIAL needed in RUSH time (leaves office/ faxed in 1-2 business days). No cost by regular mail or fax.
leaves office
______Regular official (
in 5-7 business days by regular mail or picked up***) $5.00 1
copy/ each additional + $1.00
st
leaves office
______RUSH official (
in 1-2 business days by regular mail or in person at office) $15.00 1
copy/ each additional +$1.00
st
leaves office
in USA
______RUSH w/FedEx (
in 1-2 business days by FedEx “next business day”)
$40.00 for 1
address / each additional
st
address +$25.00 / each additional copy to same address +$1.00
Accounts must be current with Business Office and Perkins loans, and exit loan counseling, if applicable, must be completed for OFFICIAL transcripts.
Requests will not be processed if required payment is not included. Contact Student Financial Services for instructions how to complete the test(s).
We accept cash, money orders, checks made to “Nyack College”, or credit/ debit information
(We accept Visa, Master Card and Discover).
DO NOT E-MAIL OR FAX CREDIT/ DEBIT INFORMATION! IT IS NOT SECURE!
Make an online payment at
https://
or call 845-675-4729 to leave the following
information on voice mail (spelled name of student whom transcript is for with their birthdate, spelled name as it appears on
the card, card number, expiration date, and CID – the 3-digit security code on the back of the card, and amount).
Office Use Only:
Perkins Loans: ___________ SFS account: ______________ Holds:____________
Date Sent: ______________
***
Please leave an approximate date & time you wish to pick up transcripts. Please call x4732 or e-mail to see if they are ready for pick-up before coming.
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